Permanent Epicardial Pacemaker Therapy in Paediatrics' Population in a Single Centre in Pakistan

Background: Permanent cardiac pacing is uncommon in children, and when performed, it is typically achieved through epicardial pacing. We analysed our clinical group's experience with epicardial pacemaker implantation.Objective: To assess our experience with epicardial pacemakers and to identify potential factors that could predict early and late lead-related complications.Materials and Methods: This study included 34 patients under the age of 12 who underwent implantation of an epicardial pacemaker between 2018 and 2020. A retrospective review of their medical records was conducted. The study was approved by the ethics committee of the institution. A thorough review of the cardiac surgical and pacemaker databases identified all the paediatric patients who underwent permanent epicardial pacemakers implantation at a tertiary care hospital of Peshawar. Adult patients with an age of were omitted to focus on paediatric cohort. Medical records were retrospectively studied.Results: For each patient, the average age across all PPM implantations, including any repeat procedures, was 7.2 ± 2.6 years. The average weight at the time of lead implantation was 24.8±4.0kg. The majority of patients who underwent pacemaker implantation or lead replacement surgery were discharged from the hospital within a week of the procedure. Of all the patients, 36.8% required a pacemaker due to post-op atrioventricular block, 28% had sinus node dysfunction, 20% had congenital complete heart block, and approximately 15.2% of the patients required a pacemaker for other reasons, including bradycardia caused by antiarrhythmic medication.Conclusion: The leads exhibited commendable longevity, enduring without significant variations based on their type. Lead and generator lifespan were unaffected by lead type, pacing mode, or patient age.Keywords: Epicardial pacemaker, Generator longevity, Lead longevity, Paediatric epicardial pacing, Single ventricle pacing.